BEHAVIORAL HEALTH RISK ASSESSMENT

Our program involves telephonic screening with a proprietary screening tool. For members that are screened as positive for a possible behavioral health condition, a face-to-face clinical assessment is scheduled. These services are utilized to markedly improve quality and overall member care, with an additional benefit of accuracy in diagnosis and documentation of behavioral health risk adjusted and non-risk adjusted diagnoses.

Health and Wellness Overview

Windstone data reveals that for a typical Medicare Advantage plan, Windstone’s professionally licensed screeners (LVN, RN, and LPT) affect a 65% member participation rate, with an average 18% of the screened members proving positive for previously undiagnosed mental health conditions. The vast majority of these cases qualify as risk adjusted diagnoses and 95% of the diagnoses are confirmed upon a follow up in-home assessment by a H&W s affiliated licensed clinician (LCSW or Psycologist). Clients that have used this model have experienced new revenue well in excess of the service cost, with the additional benefits of improved care, medical cost offset, better managed pharma benefits, and improved overall case management of co-morbid behavioral health diseases. A portion of these increased revenues are then put back into the system to provide additional patient management services.

Commercial health plans have experienced similar results. Recent data reveals that commercial plan members participate at least 60% of the time, with an average of 18% found to have an undiagnosed condition. Confirmation continues at over 90%.

Windstone believes the proactive and predictive nature of the H&W program, combined with its focus on follow up care, represents the future of managed care as well as a foundational component of any true disease management program. The H&W program delivers value through two channels: clinical and financial.

Clinical Value: Improved Care

H&W was designed specifically to improve the quality of care for membership, by being proactive in the identification, diagnosis, and treatment of behavioral conditions. All too often the approach to care has been concurrent at best and retrospective at worst. The H&W program utilizes a series of predictive tools to identify those members at highest risk for a behavioral condition.

There is a significant shortfall in the penetration of behavioral health diagnoses and care experienced by members. Of the many reasons for this gap in care, the following are most prevalent:

A mental health diagnosis is missed by the PCP 50% of the time. PCPs are not well versed in making behavioral diagnoses and therefore will generally not do so.

PCPs do not have the bandwidth in their systems to adequately address the problem even if they are comfortable making the diagnosis. As such, they generally avoid doing so.

PCPs have very limited knowledge with psychotropic medications. As such, therapy and follow-up is often prescribed or applied inappropriately.

10% of Americans suffer from depression

Suicide is the leading cause of death in ages 10-24, resulting from undiagnosed and mistreated depression

50% of the adult population will not actively seek treatment for depression

5.7 million Americans over the age of 18 suffer from Bipolar Disorder

14 million Americans suffer from drug and alcohol addiction

Generalized Anxiety Disorder affects 3.1% of the population, with women being at a higher risk